PULSE quarterly

Summer 2019

MeetFrom Aaron cardboard to concrete MountainBuilding biker. our clinic Patient. in Ridgefield Sports Medicine physician.

MoveHurt more or sick? for Knowwhole-body where healthto go

Super-moistExciting new carrot alternatives cake to open-heart surgery From cardboard to concrete Building our clinic in Ridgefield

Dr. Mark Weed, Family Medicine Department physician.

During the meetings, Dr. Weed shared some of the challenges he’s noticed as a primary care provider. For example, patients have their height, weight, and vision checked in busy hallways, which can make people feel rushed Opening August 5, 2019 or embarrassed. Providers’ offices are located at the back of each suite, which can discourage collaboration and result in a lot of walking back When the Vancouver Clinic Board of Directors A clinic that works for everyone and forth. Because the common workspace is made the decision to open up a new location To uncover what the space should look like the open to anyone passing through, it’s harder to in Ridgefield one thing was certain: The space clinic undertook a 10-month process. It started track and share sensitive patient information. should be designed around the needs of with a small team visiting other state-of-the-art caregivers and patients. health care spaces to generate ideas. Next, a Corrugated construction representative group of patients, staff, doctors, After discussing what was and wasn’t working, “Rather than working around the building, and leaders worked together to map out what the team moved on to develop a vision and we wanted to create the building around the it’s like to be a patient or caregiver at Vancouver plan for the new space. ZGF Architects drew up workflows,” said Jake Halstenson, director of Clinic. The goal was to better understand the the designs and worked out the kinks. Then the operations and specialty care at the clinic. needs and frustrations of all people and to help team tested out their dream clinic by building everyone see what goes on outside of their a full-scale model of the entire interior out of While the current clinics are beautiful and individual roles. cardboard. Walls, exam tables, cupboards, welcoming, the design is 15-plus years old. desks—everything was represented. The Medicine has changed a lot since then and the “Everyone came away realizing how much work “cardboard city,” as it was christened, stayed up new building needed to reflect innovative and goes into the patient experience—and that one for a year, giving all employees the opportunity to better ways of delivering care. person might see only a small portion of it,” said walk through it. Join us Open House preview event

“Things that look cramped on paper aren’t as “To me, I think it makes the experience more cramped in real life,” Dr. Weed said. “There’s a lot individualized,” Dr. Weed said. “When you of certainty that comes into the design when you don’t see all the chaos and other patients it helps can walk through the space.” to make the experience about you. You aren’t distracted by others’ experience.” The cardboard city confirmed to the design team that they were on the right track with a clinic that Other features are more subtle. Artwork looks markedly different than the ones patients celebrates the Ridgefield landscape. Paint colors are used to. They made the normal tweaks that and fabrics are designed to comfort and calm. come with a project of this size and moved on to Abundant light makes hallways and workspaces construction, breaking ground in June 2018. inviting for everyone.

Designed for the future “We designed the new building to facilitate Kids’ Zone At Vancouver Clinic—Ridgefield, each exam what we do best,” Dr. Weed said. “It works for us, room has two doors. The outside door leads to instead of us working around the space.” a hallway that flows out to the lobby and front of Goodies & Prizes the building, enabling patients to easily find their way. The inside door leads to a workspace that’s The new clinic offers primary and Clinic Tours shared by everyone who is caring for patients. urgent care, including pediatrics. Doctors have desks next to medical assistants, Nearby Vancouver Clinic locations in JULY nurses, and scribes, encouraging teamwork. Salmon Creek and Battle Ground will Live Music 1 Patients don’t have to pass by instruments that continue to meet the specialty care . 0 13 m are being cleaned or trip over other people in the needs of residents in Clark County. a . .m p hallways. All measurements and vitals are taken Patient care at this location starts . to 1 Meet Rally the Raptor in the room. August 5. To make an appointment, call 360-882-2778. 5515 Pioneer Street Ridgefield, WA 98642 Hurt or sick? Know where to go Urgent care Head to urgent care when you have a minor injury or illness or During a sudden or worsening can’t wait to see your regular medical event, it can be unclear doctor. where to go for care. Is it emergency room (ER)-worthy or Go to urgent care for: can urgent care evaluate and treat • Abdominal pain (mild to moderate) the issue? Because an ER visit • Acute upper respiratory infections can be costly, and wait times for (nasal congestion, sore throat, cough) non-critical issues potentially long, • Asthma (mild to moderate) many patients want to avoid an • Back pain unnecessary trip. Check out these • Dizziness (mild to moderate) lists for guidance and, of course, • Ear pain or foreign item/wax in ear always use your best judgement. • Eye infections and minor eye injuries • Fever or flu-like illnesses Never drive yourself if you • Lacerations or burns (minor) are experiencing severe pain, • Migraines and other mild headaches chest pain, shortness of breath, • Motor vehicle accidents (minor) weakness, numbness, dizziness, • Pelvic pain or vaginal discomfort impaired vision, or a severe • Sexually transmitted diseases allergic reaction. • Skin problems (rashes, abscess, boils) • Sprains and minor fractures (broken bones) • Urinary tract infections (UTIs) • Vomiting, diarrhea, or dehydration • Work injuries (workers compensation) vancouver clinic ER Urgent Care locations

Emergency room Go to the hospital or call 9-1-1 if you think that you’re dangerously ill or injured. Opening August 5, 2019 Go to the ER for: • Allergic reactions (severe) • Asthma or shortness of breath (severe) • Acute vision loss and severe eye injuries • Altered mental state or confusion • Broken bones with deformity or bones exposed • Burns (serious) • Chest pain or pressure • Fever in infants under 3 months • Head trauma or loss of consciousness • Lacerations (deep or extensive) • Physical or sexual assault Vancouver Clinic Urgent Care tips: • Poisonings or drug overdoses • All sites have X-ray available during all working hours. • Seizures • Strep throat swabs, UTI tests, and most other lab tests are available. • Severe trauma or injury • Walk in, schedule an appointment online (tvc.org/urgentcare), or call • Stroke-like symptoms (speech 360-882-2778. difficulty, weakness, numbness) • Vancouver Clinic’s Urgent Care copay is the same price as a regular • Sudden or severe headache visit. We don’t charge extra when you need to be seen right away. • Suicidal or homicidal thoughts • Uncontrolled bleeding Find a time that works for you • Vaginal bleeding in pregnancy All our locations are open 7 a.m. to 8 p.m. on weekdays, and 7 a.m. to 5 p.m. on weekends and most holidays. Many heart-disease patients have safer, more effective options than ever

Cardiologists today are witnessing The team is eager to meet the a renaissance. New technologies needs of patients who qualify for are allowing doctors to fix life- innovative approaches to heart threatening heart issues through care. They are particularly excited precise procedures instead of by three different therapies: open-heart surgery. MitraClip™ With these changes, many patients The left side of the who wouldn’t have qualified for heart is divided by an surgery previously now have a important structure solution. Individuals who in years called the mitral valve. past would have had to endure a The valve has two “leaflets” risky and invasive operation with that keep blood flowing in one a long recovery can now go home direction by opening and closing within a day or two. at the correct time. If they don’t close completely, blood can New tools offer exciting “These otherwise lethal conditions leak backward into the heart—a alternatives to are now treatable with less-invasive condition called mitral regurgitation options,” said Dr. Nathan Boyer, (MR). Several different medical Vancouver Clinic cardiologist. conditions can cause MR. Patients “It’s amazing that it’s happening in who have severe MR are frequently open-heart our lifetime.” diagnosed with heart failure, which may not always be treatable with Dr. Boyer and his colleagues in medications alone. Vancouver Clinic’s Cardiology surgery Department are keeping an eagle This is where the MitraClip comes eye on recent clinical trials and in. Doctors insert the clip through a FDA approvals. vein in the leg, threading it all the way up to the heart. “It’s like a very expensive safety Until recently, doctors used Transcatheter aortic valve TAVR has been available in the pin that tethers the two leaflets medications to manage the health replacement (TAVR) United States since 2011, but has together,” Dr. Boyer said. “You can of patients who had a PFO- Another area in which only been offered to high- and literally put the clip in and see the caused stroke. Then in 2017, The technology is replacing intermediate-risk patients. Dr. Boyer problem resolve.” New England Journal of Medicine open-heart surgery performed the first TAVR procedure published three new trials that is the treatment of in Clark County in 2016. Dr. Boyer has been performing showed that plugging the hole aortic stenosis, a condition that these procedures across the with an implant prevents more occurs when the heart’s aortic “It’s amazing. Five years ago we river at Oregon Health & Science strokes than medication alone. valve narrows. A narrow valve weren’t sure how the technology University but plans to start Inserting an implant is also less restricts blood flow to the aorta, would compare to surgery,” performing them in Vancouver risky than closing the hole via the largest artery in the body. The Dr. Boyer said. “People thought later this summer. In March 2019 open-heart surgery. heart becomes less successful at they would fail miserably. Now we the FDA approved the MitraClip delivering oxygen-filled blood to know they are a huge life saver.” for use in patients who have Once science proved that implants the body even while it works harder problems with their left ventricle— work, Vancouver Clinic Cardiology than ever. Severe aortic stenosis Recent trial results indicate that those with “secondary MR.” This Department physicians decided it can lead to heart failure, stroke, TAVR is also safer than open-heart gives new hope to a group of was a procedure that they wanted and death if left untreated. surgery for low-risk patients. Clinic people who historically had a poor and needed to offer. Dr. Boyer cardiologists expect that the FDA prognosis and few options beyond and Dr. Jane Luu, a PeaceHealth Traditionally, aortic stenosis will give doctors the green light to medication. Southwest Medical Center required open-heart surgery use it for patients of all risk levels in cardiologist, performed the first to replace a failing aortic valve. the coming months. PFO closure device three Clark County PFO closures However, doctors now know Another common via catheter in March 2019. Each that TAVR is a safer and equally Dr. Boyer believes that these three heart issue is a patent time, they inserted a catheter into effective option. During the devices and procedures mark the foramen ovale (PFO)— the groin, eased it up through the procedure, doctors insert a beginning of a new era of cardiac a hole between the veins, and implanted a tiny device catheter into the leg to guide an care, driven by technology. top two chambers to close the hole. expandable valve into the heart, of the heart. In most cases this replacing—but not removing—the “Who knows what we’ll see in hole closes shortly after birth, but “This was both gratifying and old valve. Once in place, the new the next five to 10 years, or what in about 20 percent of adults it exciting for me,” Dr. Boyer said. valve functions like a normal, currently unsolvable problems never does. Generally, the hole “It was really exciting to launch this healthy valve with proper will have options?” Dr. Boyer is harmless. However in a small therapy in Clark County.” blood flow. speculated. number of people, tiny blood clots can travel through the hole and into the brain, causing a stroke. “Who knows what we’ll see in the next five to 10 years, or what currently unsolvable problems will have options?” Summer happenings

June July August

REACH Workshop* Ridgefield 4th of July Parade North Country EMS Safety Fair 10 a.m.–12 p.m. Saturday, June 15 11 a.m. Thursday, July 4 11 a.m. Saturday, August 3 This workshop simplifies key principles for losing Come see your Vancouver Clinic care team in the Our team will be at Yacolt Primary School offering weight and becoming healthier. A dietitian will parade at Ridgefield’s 4th of July Celebration! blood pressure screenings and information about teach you how to create a plan that meets your when it is best to make a trip to urgent care needs. Ridgefield Grand Opening Event instead of the emergency room. 10 a.m.–1 p.m. Saturday, July 13 *Registration is required; please call 360-882-2778 Take a tour of the new clinic and book future Vancouver Clinic—Ridgefield opens to register. Workshops are $25 per participant. appointments! This is a family friendly event with Monday, August 5 live music by My Happy Pill, a Kids’ Zone with Urgent Care hours: 7 a.m.–8 p.m. (M–F) face painting, popcorn, popsicles, and more! 7 a.m.–5 p.m. (Weekends/Holidays) Then, join us in the evening at the Ridgefield Primary Care service hours: 8 a.m.–5 p.m. (M–F) Raptors game at 6:30 p.m. Now scheduling appointments. 360-882-2778

Camas Days Parade 11 a.m. Saturday, July 27 Come see your Vancouver Clinic care team in the Camas Days parade!

Patient Service Center Subscribe to the digital version 360-882-2778 of Pulse at tvc.org